Colonic explosion: an unavoidable complication?

 

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Endoscopy 2006; 38: 943 - 944

In a recent edition of Endoscopy, Josemanders et al. [1] presented a case report of a colonic explosion that occurred during endoscopic polypectomy. There are several statements in their discussion that cannot be left unchallenged.

Firstly, ”It is possible that insufflation of carbon dioxide instead of air could reduce the risk of explosion.“ This is clearly an understatement. As the presence of oxygen is a prerequisite for combustion and carbon dioxide on the other hand is used in fire extinguishers, insufflation of carbon dioxide rather than air should make explosion virtually impossible.

Secondly, ”Also, the use of antibiotics prior to polypectomy would lower the load of intracolonic bacteria, which could result in the production of less hydrogen and methane.“ This is a very impractical approach because it would mean that we could not remove incidental polyps found during diagnostic colonoscopy carried out for other indications, unless antibiotics were administered ad libitum as part of the bowel preparation for any colonoscopic examination. A second, antibiotic-supported colonoscopic procedure in the event of an incidental finding of polyps would certainly drive up the costs of polypectomy.

Thirdly, ”However, because of the extremely low incidence of this complication, these measures [as described in the first two points, above] are probably not cost-effective“; and, ”In conclusion, we believe that the very rare occurrence of intracolonic gas explosion during polypectomy is, practically, an unavoidable complication.“ These are the most extreme statements, and it is difficult to understand how they could have escaped the attention of the referees. A commercially available insufflator can be purchased for less than half the cost of an endoscope. It is a simple pressure-valve piece of equipment, a once-only investment with no maintenance costs, and in our hands the expense per colonoscopy in terms of gas used is less than € 0.1. Compared with the total cost of a colonoscopic examination, this is negligible, particularly when the additional benefit of reduced patient discomfort (both during and after the examination) is taken into account [2]. Although the risk of explosion during endoscopic polypectomy is very small, the cost argument for not using carbon dioxide insufflation during colonoscopy is hardly valid.

Competing interests: None

References

• 1 Josemanders D FGM, Spillenaar Bilgen E J, van Sorge A A. et al . Colonic explosion during endoscopic polypectomy: avoidable complication or bad luck?.  Endoscopy. 2006;  38 943-944
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• 2 Bretthauer M, Thiis-Evensen E, Huppertz-Hauss G. et al . NORCCAP (Norwegian colorectal cancer prevention): a randomised trial to assess the safety and efficacy of carbon dioxide versus air insufflation in colonoscopy.  Gut. 2002;  50 604-607
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G. Hoff, MD

Clinical and Registry-Based Research, Institute of Population-Based Cancer Research

Montebello

Oslo 0310

Norway

Fax: +47-22451370

Email: hofg@online.no